916. Finding the Missing Millions and Addressing Health Disparities: Automated Hepatitis B Screening and Linkage to Care

Background Globally, HBV is the most common blood-borne infection. An estimated 1.2 million people in the US and 350 million worldwide lived with HBV, a primary driver of liver cancer. It is endemic in many parts of the world and is a major health disparity in immigrant communities, including the US, which has the largest immigrant population in the world. Asian American Pacific Islanders are 5% of the total population in the US, but represent 50% of people living with HBV. In 2016, WHO set a goal of hepatitis elimination by 2030 but with only 10% of those living with HBV diagnosed, screening must be scaled up. Methods Modifications were made in the electronic medical record (EMR) to automate screening, with HBV (HBsAg) orders triggered by a patient’s country of birth or race. The began in the Emergency Department and later expanded to the Inpatient setting. Automated notifications are sent to nurse for eligible patients and then to the patient navigator (PN) for positive tests. The PN contacts the patient to provide education and arrange linkage-to-care (LTC) for evaluation and care. Results From Mar 2018 to Mar 2021, we conducted 23,883 HBV screenings. The patients originated from 173 countries based on registration; top 5 countries of origin were Haiti, Jamaica, Ecuador, Guyana, and Portugal. We found 228 (1.0%) patients with HBV infection, 101 (47%) were newly diagnosed and 182 (85%) were linked to care. We examined race and insurance status for any association with those previously tested versus newly diagnosed. Blacks were more likely to be newly identified HBV versus Asians (61.6% vs. 28.9%, p< .001), as were self-pay (uninsured) versus insured patients (66.7% vs 47.2%, p=0.043). Compared to the approximately 0.4% HBV prevalence in the US, the HBV prevalence in several towns around our hospital in Essex County is two to four times higher. Table 1. The HBV Prevalence in Towns of Essex County Conclusion Our community is diverse and social determinants of health, like race and insurance status, may contribute to provider behaviors of HBV screening with blacks receiving less screening than Asians. Automated testing programs can address health disparities and scale up screening. Such micro-elimination approaches are important for achieving global hepatitis elimination by 2030. Disclosures Su Wang, MD MPH, Gilead Sciences (Grant/Research Support)Gilead Sciences (Grant/Research Support)

Lost Years Recovered John Peters and Phillis Wheatley Peters in Middleton

A cache of Essex County legal papers reveals that when Phillis Wheatley Peters and her husband left Boston in 1780, they moved to Middleton where John became a landowner on a farm where he had been enslaved. I analyze the racial, class, and gender conflicts that led to their eviction.

Cosmopolitan county: migrant farm workers' impact on the agricultural community of Leamington

Migrant farm workers are behind-the-scenes backbone of Canada's agricultural economy. Despite their significant role within the food production industry, the outer public is typically unfamiliar with their contributions, experiences, and even their presence in Canada. Many researchers agree that workers arriving through the Seasonal Agricultural Workers Program hold a precarious status, primarily due to the invisibility of their plight to the rest of Canada. In Leamington, Ontario, large-scale greenhouse operations call for thousands of workers from Mexico and the Caribbean to grow vegetables year-round. This study sought to gain an understanding of the relationship between migrant workers and community members by surveying and interviewing Leamington residents. While worker visibility and local familiarity with the presence of migrant workers is heightened in the Essex County region, the quality of social interactions was found to be severely limited. The implications were found to involve social marginalization, culture clash, and racial stereotyping.

Cosmopolitan county: migrant farm workers' impact on the agricultural community of Leamington

Migrant farm workers are behind-the-scenes backbone of Canada's agricultural economy. Despite their significant role within the food production industry, the outer public is typically unfamiliar with their contributions, experiences, and even their presence in Canada. Many researchers agree that workers arriving through the Seasonal Agricultural Workers Program hold a precarious status, primarily due to the invisibility of their plight to the rest of Canada. In Leamington, Ontario, large-scale greenhouse operations call for thousands of workers from Mexico and the Caribbean to grow vegetables year-round. This study sought to gain an understanding of the relationship between migrant workers and community members by surveying and interviewing Leamington residents. While worker visibility and local familiarity with the presence of migrant workers is heightened in the Essex County region, the quality of social interactions was found to be severely limited. The implications were found to involve social marginalization, culture clash, and racial stereotyping.

Self-reported symptoms, self-reported viral testing result and seroprevalence of SARS CoV-2 among a community sample in Essex County New Jersey: A brief report

BackgroundSARS-CoV-2, the virus that causes COVID-19, has rapidly spread globally beginning in late 2019. Early areas impacted by this pandemic in the US include Essex County, New Jersey. Beyond understanding the prevalence of active infections and deaths, it is important to understand the true burden of infection in the community, as indicated by seroprevalence of antibodies directed to the virus. Understanding the spectrum of disease is key to the effectiveness of primary prevention and control measures and the design of interventions against transmission of infection.MethodsWe utilized venue-based-sampling (VBS), implemented by a community partner, to sample members of the community in Essex County. In VBS the venues are randomized as a proxy for randomizing the attendees of the venues. We asked standard demographic questions, questions about symptoms and PCR testing and previous antibody testing. Participants provide a blood sample collected by finger stick with the Neoteryx Mitra Collection device. Samples were tested using a novel ELISA based approached developed by our team.ResultsFrom September 15, 2020 to December 22, 2020, we conducted 92 randomly selected sampling events where we approached 1349 individuals for screening. Of these, 924 consented and had complete data for analysis. Only 6.5% of the sample reported any COVID-19 like symptoms while 45.9% had sought out a COVID-19 test. In total 13 (1.4%) participants received a positive SARS-CoV-2 PCR test result. While 33 participants (2.6%) sought a SARS-CoV-2 antibody test, only 0.5% of the sample reported a positive antibody result. Testing in this study identified 83 (9.0%) participants positive for SARS-CoV-2 antibodies.ConclusionWe recruited a large sample of the population of Essex County, New Jersey using VBS, electronic surveys, novel sample collection and lab methods. Our findings suggest that the burden of SARS-Cov-2 is slightly more than six times than that suggested by PCR testing. This burden is higher than most estimates obtained through studies of remnant blood samples from hospitals (4.2%), samples from staff at a public-school system (2.9%), and residents of a California county recruited with targeted Facebook ads (1.5%). (9-11) Moreover, with only 6.5% of the sample reporting any COVID-19-like symptoms, our finding suggests that the number of asymptomatic persons may be close to 1.5 times greater than anyone reporting symptoms.

Population Size Estimate of Men Who Have Sex with Men in Essex, New Jersey, To Inform Policy and Programming

BackgroundPopulation size estimates for key populations at risk for and living with HIV infection are key to understanding the need for and impact of HIV prevention and care. In this brief report we demonstrate approaches to estimating population size and unmet need for prevention and care among gay, bisexual, and other men who have sex with men (MSM) in Essex County, New Jersey.MethodsWe employed literature/census denominator and component methods of size estimation. We applied additional data points available electronically or in the published literature to estimate the number of undiagnosed MSM, the number of HIV negative men MSM in need of prevention programming.ResultsWe estimate a total of 11,362 MSM living in Essex County, New Jersey, of which 2,550 are HIV infected and of those 408 are not diagnosed. We estimate 8,812 HIV negative MSM in need of HIV prevention programs.ConclusionsThese estimates will allow future resources to be deployed in a more targeted and strategic manner, thereby bringing Essex County and New Jersey closer to achieving the 90-90-90 goals.

The Detroit–Windsor Border and COVID-19

This brief essay chronicles the closure of the Detroit–Windsor tunnel during the COVID-19 pandemic as part of the Canadian government’s containment measures in the spring/ summer of 2020 from the authors’ perspectives as both residents and researchers living in the border city of Windsor, Ontario (Canada). Drawing upon crossings in March and June 2020 as well as reflections on the urban cross-border context that Windsor and Detroit facilitate, the article details the changes in border operations and the resulting difficulties faced by local communities. In conclusion we point to the current, local quagmire that Windsor–Essex finds itself in, having some of the highest case COVID-19 counts in Canada as of July 2020. Caught between a laissez-faire approach to managing the migrant worker outbreaks in Essex County, and slow-moving county/provincial and federal responses to the pandemic, local attitudes toward reopening the border here seem more divided than in other parts of Canada.